Multisectoral actions in primary health care: A realist synthesis of scoping review

Abstract

Background Multisectoral actions (MSAs) on health are key to implementation of primary health care (PHC) and achieving the targets of the Sustainable Development Goal 3. However, there is limited understanding and interpretation of how MSAs on health articulate and mediate health outcomes. This realist review explored how MSAs influence on implementing PHC towards universal health coverage (UHC) in the context of multilevel health systems. Methods We reviewed published evidence that reported the MSAs, PHC and UHC. The keywords used in the search strategy were built on these three key concepts. We employed Pawson and Tilley’s realist review approach to synthesize data following Realist and Meta-narrative Evidence Syntheses: Evolving Standards publication standards for realist synthesis. We explained findings using a multilevel lens: MSAs at the strategic level (macro-level), coordination and partnerships at the operational level (meso-level) and MSAs employing to modify behaviours and provide services at the local level (micro-level). Results A total of 40 studies were included in the final review. The analysis identified six themes of MSAs contributing to the implementation of PHC towards UHC. At the macro-level, themes included influence on the policy rules and regulations for governance, and health in all policies for collaborative decision makings. The meso-level themes were spillover effects of the non-health sector, and the role of community health organizations on health. Finally, the micro-level themes were community engagement for health services/activities of health promotion and addressing individuals’ social determinants of health. Conclusion Multisectoral actions enable policy and actions of other sectors in health involving multiple stakeholders and processes. Multisectoral actions at the macro-level provide strategic policy directions; and operationalise non-health sector policies to mitigate their spillover effects on health at the meso-level. At micro-level, MSAs support service provision and utilisation, and lifestyle and behaviour modification of people leading to equity and universality of health outcomes. Proper functional institutional mechanisms are warranted at all levels of health systems to implement MSAs on health.

Multisectoral interventions and health system performance: a systematic review

“… 15 Involving non-health sectors allows for diverse community participation, addresses social determinants and financial barriers, advocates improved health outcomes and enhances the overall health system readiness to address emerging challenges. 84 , 85 Collaboration across sectors provides opportunities for integrated information systems, improving service delivery accuracy and efficiency for informed decision-making. 86 , 87 A review examining the effects of multisectoral collaboration on health and well-being also found improvements in service delivery, efficiency and effectiveness, but limited evidence for change in health outcomes.…”

“…In our reviewed publications, we noted a common theme of the facilitation of community participation. Multisectoral interventions empower communities to engage in their health and well-being 85 by breaking down barriers between sectors and taking an active role in shaping their health outcomes. 90 , 91 This approach contributes to immediate improvements in service acceptability and fosters a sense of ownership and agency among community members.…”

“…Community participation becomes a driving force behind the sustained success of multisectoral interventions, enhancing health system performance over time. 85 …”

“… 9 , 10 , 89 Multisectoral collaboration for health is essential for health system strengthening to promote health improvement and equity. 15 , 85 …”

Multisectoral action and community involvement are required for long-term improvements in public health

“…A recent Editorial in PHA highlighted the importance of Community Connect at the Union’s World Conference on Lung Health. 11 This forum recognises the importance of communities and leverages their strengths to make meaningful progress on the End-TB Strategy. There is also a need to enhance collaboration between other sectors (e.g., housing, environment and economy) and groups (e.g., government, civil society and the private sector).…”